Significant geographic, operator, and institutional variation noted in utilization of TRA
THURSDAY, Nov. 2, 2017 (HealthDay News) — Use of transradial access (TRA) for ST-elevation myocardial infarction (STEMI) percutaneous coronary intervention (PCI) increased from 2009 to 2015, with considerable geographic, operator, and institutional variation, according to a study published online Nov. 1 in JACC: Cardiovascular Interventions.
Javier A. Valle, M.D., from the University of Colorado School of Medicine in Aurora, and colleagues described patient, operator, and institutional characteristics associated with TRA use for STEMI PCI and determined variation in use from 2009 to 2015.
The researchers found that 12 percent of the 692,433 patients undergoing STEMI PCI used TRA. There was an increase in TRA from 2 to 23 percent from 2009 to 2015, with significant geographic variation. There were associations for age, gender, cardiogenic shock, cardiac arrest, operators entering practice before 2012, and non-academically affiliated institutions with lower TRA rates. Significant operator and institutional variation was seen, wherein identical patients would have more than eight- and five-fold difference in the odds of TRA for STEMI PCI, respectively, by changing operators and institutions. Across operators, greater TRA use was correlated with reduced bleeding, and TRA use across institutions was correlated with reduced mortality.
“Transradial access for STEMI PCI is increasing but remains underutilized with significant geographic, operator, and institutional variation,” the authors write.
Several authors disclosed ties to the pharmaceutical and medical device industries.
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